Joint perception and patient perceived satisfaction after total hip and knee arthroplasty in the American population

Abstract

Background: Total hip (THA) and knee arthroplasty (TKA) are two of the most successful procedures in orthopedics. Current evaluation trends focus on patient-reported outcomes. We sought to compare the changing WOMAC scores from various time points from pre-operative to 1-year follow-up between separate THA and TKA cohorts. In addition, we compared THA and TKA patients' joint perception, satisfaction, and function via a questionnaire.

Methods: One hundred elective THA (n = 50) and TKA (n = 50) patients at one institution were randomly selected and contacted between 2 and 4 years after the index surgery. A questionnaire assessed joint perception, satisfaction and function of their total joint. Clinical function scores utilizing the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from the pre-operative, 3-month and 1-year post-arthroplasty visits were compared between groups.

Results: 78% of the THA group perceived their replaced joint as "native" vs 32% of TKA patients. 54% of THA patients (vs 16% of TKA patients) reported uninhibited function of their total joint. 24% of TKA patients noted to be least satisfied with their total joint compared to 2% in the THA group. Both groups demonstrated significant improvement in WOMAC scores after surgery, but the mean 3-month (12.4 (THA) vs 19.3 (TKA)) and 1-year (6.5 (THA) vs 14.1 (TKA)) follow-up WOMAC scores were significantly better in the THA group.

Conclusion: Evaluation of a patient's joint perception is a valuable tool that should be used to assess function in conjunction with validated clinical functional scores. Our data suggest further improvements in total knee implant design and implantation strategies are necessary.

Keywords: Adult reconstruction; Joint perception; Total hip arthroplasty; Total joint arthroplasty outcomes; Total knee arthroplasty; WOMAC scores.

Fig. 1

WOMAC and Delta-WOMAC score comparisons between THA and TKA groups. Scores are presented as means and include the pre-operative, and 3-month and 1-year post-operative WOMAC scores. In addition, the Delta-WOMAC scores represent the change in score from the pre-operative to 3-month post-operative (= “D1”) period, the pre-operative to 1-year post-operative (=”D2”) period, and the 3-month to 1-year post-operative score change (=”D3”).

Fig. 2

Patient-reported total joint perception following THA vs TKA. All patients (n = 50) in each cohort were asked how they perceive their total joint following THA or TKA.

Fig. 3

Patient satisfaction scores following THA vs TKA. All patients (n = 50) in each cohort were asked to rate their level of satisfaction from 1 (=not at all satisfied) to 10 (=most satisfied). Satisfaction ratings from 1 to 6 were considered “least satisfied” ratings and are marked with an asterisk (*). Patient satisfaction scores from 7 to 10 were considered “overall satisfied” with their procedure.

Fig. 4

Patient-reported functional levels following THA vs TKA. All patients (n = 50) in each cohort were asked to select the most appropriate response indicating their current functional level of their total joint replacement.